气囊辅助内镜诊治成人梅克尔憩室并出血病例分析

Balloon-assisted endoscopic diagnosis and treatment for adult Meckel’s diverticulum(MD)patients with gastrointestinal bleeding

目的探讨气囊辅助内镜在成人梅克尔憩室(Meckel’s diver-ticulum,MD)并出血诊治中的临床应用价值。方法回顾性分析2012年11月至2019年6月空军特色医学中心经气囊辅助内镜诊治的46例MD并出血的成人患者的临床资料。46例患者均以首次或数年间断、反复血便、黑便就诊,经空军特色医学中心气囊辅助内镜检查发现MD及出血病灶,明确消化道出血原因。结果46例患者,检查中发现憩室内肿物5例,溃疡25例,憩室恶变1例,其余15例因憩室口径小,内镜无法进入憩室内部观察情况,经外科术中剖面观察及病理证实。病理结果:5例憩室内肿物,病理均为异位胃黏膜慢性炎;25例溃疡周围活检,2例为异位胰腺,18例为异位胃黏膜慢性炎,5例为回肠黏膜慢性炎;1例憩室癌变-中分化腺癌;口径小的15例外科手术,憩室底部可见糜烂或溃疡,14例为异位胃黏膜,1例为异位胰腺。46例患者最终接受腹腔镜手术或开腹手术,术后随访至今未再出现消化道出血,1例憩室癌变患者最终因远处转移死亡。结论对不明原因消化道出血的青年患者,要首先考虑MD伴出血的可能,气囊辅助内镜可直接发现并观察憩室的形态、大小和病变情况,具有明确病因的高效性,可作为这类患者检查的首选方法。明确消化道出血的病因后,对于合并出血的MD治疗的根本方法是外科手术,具有良好的长期疗效。

Objective To analyze the value of balloon-assisted enteroscopy(BAE)in the diagnosis and treatment for adult Meckel’s diverticulum(MD)patients with gastrointestinal bleeding.Methods The clinical data of 46 adult MD patients with gastrointestinal bleeding who received BAE was retrospectively analyzed.All 46 patients suffered from melena or hematochezia.BAE identified MD and lesions leading to bleeding.Results Of all the 46 patients,tumor was found in 5 MD patients,ulcer was found in 25 MD patients,malignant tumor was found in 1 MD patient.The opening of MD in 15 patients was too small to observe the inside of the MD by enteroscopy.The 5 tumors were proven to be chronic inflammation of ectopic gastric mucosa by pathology.Biopsy of the 25 ulcerous lesions identified 2 cases of ectopic pancreas,18 cases of ectopic gastric mucosa,and 5 cases of ileac mucosa.One case was identified as malignant change of MD.Surgery found erosion or ulcer in the 15 small opening MD cases.And the post-surgery pathology identified 14 case of ectopic gastric mucosa and 1 case of ectopic pancreas.All patients underwent laproscopic or laparotomy operation.No gastrointestinal bleeding occurred during follow-up up to date.The patient with malignant tumor died from metastasis.Conclusions MD with gastrointestinal bleeding should be considered gastrointestinal bleeding occurred to young patients.BAE could diagnose and observe the morphological characteristics and the size of MD.Thus,BAE is efficient and should be considered a first line diagnostic method.Surgery is the preferred treatment for MD with gastrointestinal bleeding.It has good long-term curative effect.